The most important lesson globally is that, given the scale and the diversity of the changes required, the development of a truly coordinated system, focused on population health, cannot be a single ‘big bang’ change project. It involves new skills, new ways of being paid and a new dynamic between physicians and patients. It is a journey that requires skilled change management, experimentation and development across a wide range of activities over considerable time.
McClellan M et al have devised the maturity matrix (see below) to describe the progression towards coordinated care in five key areas: population health; measuring outcomes; metrics and learning; payments and incentives; and coordinated delivery.
Agreement about where you are on this journey and what your goals are in these domains may be helpful for health systems seeking to develop the necessary capabilities, infrastructure and relationships with their stakeholders and patients. The maturity matrix shows how, if you want to move towards delivering coordinated care, you will need to tackle a number of different issues at the same time, but that progress can be staged and visualized.
For example, a health system might start from a position of not identifying a population at all, then begin to define and stratify its population through individual key morbidities and, eventually, reach the point of being able to identify groups of patients with specific combinations of conditions and design services accordingly.
Source: From McClellan M et al (2014) Accountable care around the world: a framework to guide reform strategies, in Health Affairs, 33 (9) 1507.